Accurate risk scores, backed by the chart.
Codithrive Healthcare helps health plans, provider groups and ACOs turn clinical documentation into accurate, compliant risk scores. Our certified coders capture every condition the record supports, validate each HCC against MEAT criteria and maintain a clear evidence trail for RADV.
- Chart retrievedNotes, labs and specialist visits collectedWaiting
- Coded by certified coderICD-10-CM codes mapped to V28 HCCsWaiting
- MEAT evidence checkedEach condition linked to supporting notesWaiting
- Provider query sentUnclear diabetes complication clarifiedWaiting
- QA passed and submittedSecond-level review before submissionWaiting
Who we support
- Health plans
- Provider groups
- ACOs and MSOs
- Hospitals
- Coding companies
The gaps that quietly erode risk scores
Risk scores miss in two directions: chronic conditions that were treated but never coded, and codes the medical record cannot defend. Both carry a measurable financial cost.
Undocumented chronic conditions
Conditions managed during the year never reach a submission, so the risk score understates true patient complexity and funding falls short.
Codes without clinical support
HCCs submitted without clear MEAT evidence become repayment exposure the moment a RADV audit begins.
Seasonal review backlogs
Retrospective charts accumulate ahead of submission deadlines, forcing rushed reviews and missed diagnoses.
A model that keeps moving
CMS-HCC V28 reshaped which diagnoses carry weight. Coding habits built on V24 now leave gaps or introduce errors.
Risk adjustment at the core. Every supporting service around it.
Begin with risk adjustment coding, then extend into documentation, quality, staffing, training or revenue cycle support as your program grows. One partner, one standard of accuracy.
Risk adjustment coding
Certified risk adjustment coders review every encounter and capture each condition the record supports. Nothing added, nothing missed.
Retrospective chart review
Full-year chart review to find missed and unsupported HCCs before the submission deadline.
Prospective review
Pre-visit chart summaries that show providers which chronic conditions need to be addressed this year.
Concurrent and pre-bill review
Encounters coded and checked soon after the visit, while the provider can still clarify the note.
HCC validation and model mapping
ICD-10-CM codes validated and mapped to CMS-HCC V28, HHS-HCC and other risk models.
RADV audit support
Medical record selection, coding validation and documentation packets for CMS and HHS audits.
Medical record retrieval
Secure chart collection from provider offices, hospitals and EHRs, tracked until complete.
Clinical documentation improvement
Accurate coding begins with complete documentation. Our CDI specialists help providers write notes that reflect the true clinical picture of every patient.
Concurrent and retrospective CDI review
Notes reviewed for clarity, specificity and missing detail, during the stay or after the visit.
Compliant provider queries
Clear, non-leading queries that ask providers to clarify, never to add a diagnosis.
HCC specificity documentation
Guidance on documenting severity, complications and status so conditions map correctly.
Provider education and feedback
Short, specialty-specific sessions and tip sheets based on each provider's real charts.
Inpatient CDI
Documentation review that supports accurate DRG assignment and severity reporting.
CDI program setup and reporting
Workflows, query templates and monthly metrics such as query response rate.
Quality assurance and auditing
Independent, evidence-based review that proves your coding accuracy before an external auditor tests it.
Second-level QA on coded charts
A senior coder reviews coded charts before submission and corrects errors at source.
Coding accuracy audits
Audits of your in-house coders or another vendor, with accuracy scored code by code.
Mock RADV audits
A sample of submitted HCCs tested against the chart the way CMS would test them.
Compliance and risk review
Unsupported codes, query practices and coding policies checked against official guidelines.
Provider and coder scorecards
Accuracy and documentation trends by person, so training goes where it is needed.
Audit reports and action plans
Clear findings, financial impact and a corrective plan your team can act on.
Healthcare staffing
Credentialed coding and revenue cycle professionals who integrate into your workflow quickly, for a single project or the long term.
Risk adjustment coders
Certified risk adjustment coders for retrospective, prospective and audit work.
Inpatient and outpatient coders
Professional fee, facility and specialty coders matched to your setting.
CDI specialists and auditors
Experienced reviewers for documentation programs and coding audits.
Billing and AR staff
Billers, AR callers and payment posters for revenue cycle teams.
Project and seasonal staffing
Extra coders for retrospective season, backlogs or a new contract ramp-up.
Dedicated managed teams
A full team that works only on your account, supervised and quality-checked by us.
Training and certification
Structured, practical training that builds productive new coders and keeps experienced teams current with every guideline change.
Certification exam preparation
Coaching for AAPC and AHIMA exams such as CRC and CPC, with practice tests and review.
Risk adjustment coder training
Hands-on training on real-style charts: ICD-10-CM, HCC mapping and MEAT documentation.
Model and code-set update training
Updates on CMS-HCC V28, yearly ICD-10-CM changes and new official guidelines.
Provider documentation workshops
Short sessions for physicians and clinical staff on documenting chronic conditions.
Client team upskilling
Training programs for your in-house coders, built around their audit findings.
Progress tracking
Accuracy tests before and after training, so you can see the improvement.
Revenue cycle services
For providers who also need claims paid accurately and on time. The same quality standards, applied across the revenue cycle.
Eligibility and prior authorization
Coverage verified and authorizations secured before the visit.
Medical coding and charge entry
ICD-10-CM, CPT and HCPCS coding with clean charge entry.
Claims, denials and AR follow-up
Claims scrubbed and submitted, denials appealed and aging AR worked to closure.
Payment posting and reporting
ERA and EOB posting with monthly collection and denial reports.
Credentialing and enrollment
Payer enrollment and re-credentialing so providers can bill without delay.
HEDIS and quality abstraction
Measure abstraction and data validation for quality reporting programs.
Estimate the revenue hidden in undocumented HCCs
Adjust the inputs to reflect your Medicare Advantage population for a directional estimate. A complimentary chart audit replaces it with the real figure from your own records.
Estimated revenue not captured each year
Simple estimate: members × base payment × missed risk score × 12. Only conditions supported in the medical record should ever be coded.
In-house coding vs. Codithrive Healthcare
An in-house team performs well until review season, a model update or an audit stretches it beyond capacity. Here is what changes with a dedicated partner.
| Area | Doing it in-house | With Codithrive Healthcare |
|---|---|---|
| Coders | Hard to hire and keep certified risk adjustment coders | A certified team ready to start, with backup cover |
| Accuracy | One review per chart, errors found later | Second-level QA before anything is submitted |
| Audit risk | Codes submitted without a clear evidence trail | Every HCC linked to MEAT evidence in the note |
| Model changes | Team must relearn V28 and yearly code updates alone | Coders trained on every model and code set update |
| Peak season | Backlogs before submission deadlines | Extra coders added for the season, then scaled back |
| Cost | Salaries, training, software and turnover | One predictable fee, agreed after the audit |
From first conversation to full production
A short, supervised onboarding that lets you validate our quality before you scale.
Complimentary chart audit
We code a sample of your charts to surface missed HCCs and codes the record cannot support.
Written findings reportGuidelines and secure access
We align with your coding policies, risk models and systems, then execute the BAA and configure secure access.
No change to your workflowPilot with dual-level QA
Our coders begin on live charts with full second-level review while your team validates the results.
Your approval before scale-upFull production
We take on the agreed volume and report accuracy, capture rate and turnaround every month.
Monthly performance reviews
Choose the engagement that fits your program
Every engagement begins with the same complimentary chart audit. The right model is decided once we have reviewed your charts.
Project review
A defined volume of charts, such as a retrospective season or an audit sample, delivered to a fixed deadline.
- Fixed scope and deadline
- Good for backlogs and peak season
- Easy to repeat next year
Full risk adjustment program
Coding, CDI and quality assurance run together year-round as one connected, accountable program.
- Retrospective and prospective reviews
- Provider queries and education
- Monthly accuracy and capture reports
Staffing and training
Credentialed coders who join your team, or structured training that strengthens the team you already have.
- Contract or long-term staff
- Exam preparation and upskilling
- Suits plans, groups and coding companies
Charts coded across every clinical specialty
Chronic conditions surface in primary care, specialist and facility records alike. Our coders know where to find them in each.
Primary and internal care
Where most chronic conditions are first managed
- Primary care
- Internal medicine
- Family medicine
- Geriatrics
- Urgent care
Specialist care
Complex conditions that carry significant risk weight
- Cardiology
- Nephrology
- Endocrinology
- Pulmonology
- Oncology
- Neurology
- Behavioral health
- Gastroenterology
- Rheumatology
- Vascular surgery
- Orthopedics
Hospital and post-acute
Facility and transitional-care records
- Hospital inpatient
- Hospital outpatient
- Emergency medicine
- Home health
- Skilled nursing facility
- Hospice
No match found. Ask our team about your specialty.
Every major risk model, coded inside your systems
Our coders work directly in your EHR or coding platform through secure, role-based access. No data migration, no new software.
- CMS-HCC V28
- CMS-HCC V24
- HHS-HCC (ACA)
- RxHCC
- CDPS+Rx (Medicaid)
- ESRD model
- Epic
- Oracle Health (Cerner)
- athenahealth
- eClinicalWorks
- NextGen
- Your coding platform
Coverage aligned to your office hours
Shifts are planned around your time zone, so charts keep moving while your team is at work.
Protected health information, safeguarded at every step
You entrust us with medical records and the integrity of your risk scores. Both are handled with the same rigor your clinical teams bring to patient care.
HIPAA-aligned processes
Business associate agreement signed with every client before any access.
Controlled access
Role-based logins, encrypted connections and no data stored on personal devices.
Certified coding staff
Coders hold recognised credentials and train on every model and code set update.
Official guidelines only
Coding follows ICD-10-CM Official Guidelines and supports only what the chart documents.
Answers for health plans and provider groups
Need something more specific? Our team responds within one business day.
Ask a questionWhat is risk adjustment coding?
Risk adjustment coding is the process of reviewing medical records and assigning ICD-10-CM codes for the chronic and serious conditions a patient has. These codes map to Hierarchical Condition Categories (HCCs), which help set a risk score that tells payers how much care a member is expected to need.
What is a RAF score and why does it matter?
A Risk Adjustment Factor (RAF) score shows how complex a member's health is compared with the average. It directly affects how much a Medicare Advantage or ACA plan is paid for that member, so missed conditions mean underpayment and unsupported codes mean audit risk.
What changed with CMS-HCC V28?
CMS-HCC V28 is the risk model CMS uses for Medicare Advantage payments and is fully in use from payment year 2026. It reorganised the HCCs and removed many diagnosis codes from payment, so documentation must be more specific than before.
What are the MEAT criteria?
MEAT stands for Monitor, Evaluate, Assess or Address, and Treat. A condition should be coded only when the note shows the provider did at least one of these during the visit. Our coders link every HCC to that evidence.
How do you keep codes ready for RADV audits?
Every HCC is supported by MEAT evidence, checked in second-level QA and recorded with the page and note it came from. We also run mock RADV audits so problems are found before CMS finds them.
Do you provide coders on a staffing basis?
Yes. We provide certified risk adjustment coders, inpatient and outpatient coders, CDI specialists, auditors and billing staff, for projects, peak season or long-term roles.
Do you offer training and certification preparation?
Yes. We train new and experienced coders on risk adjustment, model updates and documentation, and prepare them for AAPC and AHIMA certification exams. The certifications themselves are awarded by those organisations.
Do you still provide medical billing and RCM?
Yes. Along with risk adjustment, we support providers with eligibility, coding, claims, denial management, AR follow-up and payment posting.
Is member data safe with you?
Member data is handled through HIPAA-aligned processes: role-based access, encrypted connections, signed business associate agreements and regular internal audits.
Find out what your charts are missing
Share a few details and our team will arrange a complimentary chart audit. No cost and no obligation.
- Missed HCCs identified in your sample charts
- Codes the record cannot support, flagged for audit risk
- Documentation gaps mapped by provider and condition
- A clear proposal, only if you request one